摘要
目的探讨左旋甲状腺素(L-T4)替代治疗妊娠合并亚临床甲状腺功能减退(SCH)的初始剂量选择及其效果。方法选取江苏省如皋市人民医院2016年1月—2018年2月确诊的妊娠合并SCH患者100例为研究对象。根据患者用药剂量分为高剂量组(起始剂量为50μg,1次/d)和低剂量组(起始剂量为25μg,1次/d),每组50例。比较两组治疗前后游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、叶酸(FA)、一氧化氮(NO)、内皮素-1(ET-1)水平,动脉血流介导的内皮依赖性舒张功能(FMD)及两组妊娠结局、围生儿结局。结果治疗前两组甲状腺功能指标及FA水平比较,差异无统计学意义(P>0.05)。治疗后,两组TSH水平低于治疗前,FA水平高于治疗前;且高剂量组TSH水平低于低剂量组,FA水平高于低剂量组,差异均有统计学意义(均P<0.05);两组FT3、FT4水平比较,差异无统计学意义(P>0.05)。治疗前两组NO、ET-1、FMD水平比较,差异无统计学意义(P>0.05)。治疗后,两组ET-1水平低于治疗前,NO、FMD水平高于治疗前;高剂量组ET-1水平低于低剂量组,NO、FMD水平高于低剂量组,差异均有统计学意义(均P<0.05)。高剂量组产科相关并发症发生率低于低剂量组,差异有统计学意义(P<0.05)。高剂量组胎儿及围生儿不良结局总发生率低于低剂量组,差异有统计学意义(P<0.05)。结论妊娠合并SCH患者采用50μg的L-T4替代治疗较25μg能更有效的调节甲状腺素水平、内皮功能,对于降低产科并发症、胎儿及围生儿不良结局发生率具有积极作用。
Objective To explore the initial dose selection and effect of Levothyroxine(L-T4)replacement therapy in pregnant patients with subclinical hypothyroidism(SCH).Methods A total of 100 pregnant patients with SCH diagnosed in Rugao People’s Hospital of Jiangsu Province from January 2016 to February 2018 were selected as the research subjects.They were divided into high-dose group(initial dose 50μg,once a day)and low-dose group(initial dose 25μg,once a day)according to drug dose,with 50 cases in each group.The levels of free triiodothyrogenine(FT3),free thyroxine(FT4),thyrotropin(TSH),folic acid(FA),nitric oxide(NO),endothelin-1(ET-1),arterial flow mediated endothelium-dependent dilation(FMD),pregnancy outcome and perinatal outcome of two groups were compared before and after treatment.Results There were no significant differences in thyroid function and FA level between two groups before treatment(P>0.05).After treatment,TSH level was lower than that before treatment,and FA level was higher than that before treatment;TSH level of high-dose group was lower than that of low-dose group,and FA level of high-dose group was higher than that of low-dose group,with statistical significances(all P<0.05);and there were no significant differences in FT3 and FT4 levels between two groups(P>0.05).Before treatment,there were no significant differences in NO,ET-1 and FMD levels between two groups(P>0.05).After treatment;ET-1 level of two groups was lower than that before treatment,NO and FMD levels were higher than those before treatment.ET-1 level in high-dose group was lower than that in low-dose group,and NO and FMD levels in high-dose group were higher than those in low-dose group,with statistical significances(all P<0.05).The incidence of obstetric complications in high-dose group was lower than that in low-dose group,with statistical significances(P<0.05).The total incidence of fetal and perinatal adverse outcomes in high-dose group was lower than that in low-dose group,with statistical significances(P<0.05).Conclusion L-T4 replacement therapy of 50μg is more effective in regulating thyroxine level and endothelial function in pregnant patients with SCH than that of 25μg,and has a positive effect on reducing the incidence of obstetric complications and fetal and perinatal adverse outcomes.
作者
刘铭兰
肖黎明
施尉红
LIU Minglan;XIAO Liming;SHI Weihong(Department of Obstetrics and Gynecology,Rugao People’s Hospital,Jiangsu Province,Rugao226541,China;Department of Obstetrics and Gynecology,Nantong Maternal and Child Health Hospital,Jiangsu Province,Nantong226006,China)
出处
《中国医药导报》
CAS
2021年第5期80-83,共4页
China Medical Herald
基金
江苏省妇幼保健科研项目(F201407)。
